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Discussion of the future of pediatric hospitalists
General pediatric hospitalists are playing an increasing role as educators for medical students and pediatric residents, and new pediatricians fresh from residency training are selecting general inpatient care as a career goal. This "new" role for pediatricians is touted as a way to improve inpatient care, shorten hospital stays, and reduce costs, and there is some evidence that hospitalists will meet those expectations.1 Role models are often helpful, however, and I'd like to describe a pediatric hospitalist who was proud to claim that title long before most of us knew what it meant.
Frederick J. Heldrich, Jr. spent 11 years in private practice in Frederick, Md., before becoming the Chairman of the Department of Pediatrics at St. Agnes Hospital in Baltimore in 1970. He spent the next 22 years overseeing the care of pediatric patients and a pediatric residency program in that community hospital. When he "retired" from that position in 1992 he joined the full-time faculty in the Department of Pediatrics at Johns Hopkins, where he served as ward attending on the general inpatient service and teaching attending for medical students until just months before he died in January 2007, at the age of 82.
Fred Heldrich relished the role of teacher and clinician in an environment that fostered inquiry, collegiality, and collaboration. In an article about pediatric hospitalists published in Contemporary Pediatrics in 19992 , Fred discussed the importance of assessing the needs of both the community and the hospital in making a decision about whether hospitalists will enhance the care of patients. In reviewing Dr. Heldrich's extensive CV, I was struck by the aspects of his career that provide a model for today's pediatric hospitalists. The case reports he contributed to the literature reflect not only his astute observational skills but also his understanding of the importance of communicating with the community pediatrician in gathering historical data and an impression of the family, and in continuing to learn about the patient's course after discharge. His article regarding hyperbilirubinemia in newborns with hemolytic disease due to ABO incompatibility, and one regarding a neutrophil-killing defect in patients with varicella, involved collaboration with physicians at other institutions who shared his interests. And many of his published articles highlight a component of patient care he emphasized in working with residents: the importance of talking to consultants face-to-face, including radiologists and pathologists, with the relevant studies available for review. He had always read the most recent publications, but he also taught every resident why the stool of a patient with cystic fibrosis had a different effect on x-ray film than that of an unaffected child.
Dr. McMillan, editor-in-chief of Contemporary Pediatrics, is professor of pediatrics, vice chair for pediatric education, and director of the pediatric residency training program, Johns Hopkins University School of Medicine, Baltimore.
1. Landrigan CP, Conway PH, Edwards S, et al: Pediatric hospitalists: A systematic review of the literature. Pediatrics 2006;117:1736
2. Heldrich FJ: When pediatric hospitalists make sense. Contemporary Pediatrics 1999;16:117